# Evaluating the Impact of Audits and Re-audits on Adherence to the Ottawa Knee Rules in a High-Volume UK Trauma Centre

## TL;DR

This study shows that education significantly improved adherence to the Ottawa Knee Rules for reducing unnecessary knee X-rays in a UK hospital.

## Contribution

Demonstrates the effectiveness of educational interventions in improving clinical guideline adherence in trauma care.

## Key findings

- Compliance with OKR criteria increased from 41% to 91% after educational interventions.
- Specific indicators like inability to bear weight and isolated patellar tenderness saw significant improvements.
- Sustained training and audits are needed to maintain high adherence to clinical guidelines.

## Abstract

Background

The Ottawa Knee Rules (OKR) are a validated clinical decision-making tool designed to minimise unnecessary radiographs in knee trauma, thereby reducing radiation exposure, optimising resource utilisation, and streamlining patient management. This study audits and re-audits the clinical compliance with OKR in radiography referrals by the Orthopaedic and Emergency Department (ED) teams at Salford Royal NHS Foundation Trust.

Methodology

A two-cycle retrospective audit was conducted, examining knee X-ray request forms submitted between October 2023 and March 2024 (Cycle 1) and March 2024 and September 2024 (Cycle 2). Each request was evaluated against the OKR criteria and cross-referenced with corresponding clinical notes. Target compliance was 100%. Educational interventions were implemented after Cycle 1 to improve adherence.

Results

In Cycle 1, only 41% of referrals documented at least one OKR criterion. This improved significantly to 91% in Cycle 2. Notable improvements were observed in specific OKR indicators, including documentation of inability to bear weight (14% to 57%) and isolated patellar tenderness (13% to 72%).

Conclusions

Educational interventions substantially improved OKR compliance among ED and Orthopaedic staff. Sustained efforts, including regular training and audits, are essential to maintain adherence, reduce unnecessary imaging, and ensure high-quality patient care.